Provider Demographics
NPI:1427633593
Name:LA ESPERANZA MEDICAL GROUP
Entity type:Organization
Organization Name:LA ESPERANZA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-748-3629
Mailing Address - Street 1:132 HIALEAH DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5250
Mailing Address - Country:US
Mailing Address - Phone:305-748-3629
Mailing Address - Fax:
Practice Address - Street 1:132 HIALEAH DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5250
Practice Address - Country:US
Practice Address - Phone:305-303-7395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty